Diabetic foot ulcer (DFU) including amputation surgery has serious consequences for patients, the family and healthcare services. DFU affects not only the physical health-related quality of life (HRQoL) of patients but also their mental well-being. The aims of this study were to find the predictors of HRQoL after surgery, to analyse differences in HRQoL, before and after surgery, and to explore the moderating role of a first versus previous amputation(s) in the relationship between physical and mental HRQoL, before and after surgery, in patients with DFU.
A longitudinal study comprising 108 Portuguese patients was conducted during the period of hospitalization before the surgery and at a follow-up consultation. Participants completed a socio-demographic questionnaire and the SF-36 to assess HRQoL.
Physical and mental HRQoL before surgery predicted HRQoL after surgery, as well as the number of diabetes complications and having received a re-amputation. Physical HRQoL decreased after surgery, but there were no differences on mental HRQoL. Having a previous amputation was a moderator between physical and mental HRQoL before and after surgery.
The results help to identify the most vulnerable patients at risk of having lower HRQoL after surgery, allowing interventions to be tailored to patients’ needs in order to promote their quality of life.
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Portuguese Diabetes Society. Diabetes: Factos e Números 2012: Relatório Anual do Observatório Nacional da Diabetes. 2014. Portuguese Diabetes Society [Diabetes: Facts and Numbers 2012: annual report from Diabetes National Observatory].http://www.portaldasaude.pt/NR/rdonlyres/3653C7E4-6035-4E42-9CBC-4ABC63062419/0/i018361.pdf. Accessed 10 July 2015.
Margolis DJ, Malay DS, Hoffstad OJ. Economic burden of diabetic foot ulcers and amputations. In: DataPoints publication series. Rockville: Agency for Healthcare Research and Quality (US); 2011.
Reiber GE, Lipsky BA, Gibbons GW. The burden of the diabetic foot ulcer. Am J Surg. 1998;176(Suppl 2A):5–10.
Vileikyte L. Diabetic foot ulcers: a quality of life issue. Diabetes Metab Res Ver. 2001;17(4):246–9.
Ikem RT, Ikem IC, Ola BA. Relationship between depression, cognitive function and quality of life of Nigerians with diabetic foot ulcers, a preliminary controlled study. Acta Endocrinol. 2009; V(1):75–83. doi:10.4183/aeb.2009.75.
Ribu L, Hanestad BR, Moum T, Birkeland K, Rustoen T. A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population. Qual Life Res. 2007;16:179–89.
Valensi P, Girod I, Baron F, Moreau-Defarges T, Guillon P. Quality of life and clinical correlates in patients with diabetic foot ulcers. Diabetes Metab J. 2005;31:263–71.
Yekta Z, Pourali R, Ghasemi-rad M. Comparison of demographic and clinical characteristics influencing health-related quality of life in patients with diabetic foot ulcers and those without foot ulcers. Diabetes Metab Syndr Obes. 2011;4:393–9. doi:10.2147/DMSO.S27050.
Gilpin H, Lagan K. Quality of life aspects associated with diabetic foot ulcers: a review. Diabetic Foot J. 2008;11(2):56–62.
Ashford RL, McGee P, Kinmond K. Perception of quality of life by patients with diabetic foot ulcers. Diabetic Foot J. 2000;3:150–5.
Brod M. Quality of life issues in patients with diabetes and lower extremity ulcers: patients and care givers. Qual Life Res. 1998;7(4):365–72.
Ribu L, Wahl A. Living with diabetic foot ulcers: a life of fear, restrictions, and pain. Ostomy Wound Manag. 2004;50:57–67.
Haria JM, Singh VK, Jani SK. Life with diabetic foot ulcer: a cross sectional study. IJSS. 2014;1(6):33–5.
Goodridge D, Trepman E, Embil JM. Health-related quality of life in diabetic patients with foot ulcers: a literature review. J Wound Ostomy Continence Nurs. 2005;32(6):368–77.
Goodridge D, Trepman E, Sloan J, Guse L, Strain LA, McIntyre J, et al. Quality of life of adults with unhealed and healed diabetic foot ulcers. Foot Ankle Int. 2006;27(4):272–80.
Meijer JWG, Trip J, Jaegers SMHJ, Links TP, Smits AJ, Groothoff JW, et al. Quality of life in patients with diabetic foot ulcers. Disabil Rehabil. 2001;3(8):336–40.
Nabuurs-Franssen MH, Huijberts MSP, Nieuwenhuijzen Kruseman AC, Willems J, Schaper NC. Health-related quality of life of diabetic foot ulcer patients and their caregivers. Diabetologia. 2005;48(9):1906–10.
Fejfarová V, Jirkovská A, Dragomirecká E, Game G, Bém R, Dubský M, et al. Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus? J Diabetes Res. 2014; 1–7. doi.org/10.1155/2014/371938
Douglas V. Living with a chronic leg ulcer: an insight into patients’ experiences and feelings. J Wound Care. 2001;10(9):355–60.
Monami M, Longo R, Desideri CM, Masotti G, Marcgionni N, Mannucci E. The diabetic person beyond a foot ulcer: healing, recurrence and depressive symptoms. J Am Podiatr Med Assoc. 2008;98(2):130–6.
Carrington AL, Mawdsley SKV, Morley M, Kincey J, Boulton AJM. Psychological status of diabetic people with or without lower limb disability. Diabetes Res Clin P. 1996;32(1–2):19–25.
Carrington AL, Mawdsley SKV, Morely M. The psychological assessment of diabetic people with or without foot ulcers or lower limb amputations. In: Hotta N, Greene DA, Ward JD, Sima AAF, Boulton AJM, editors. Diabetic neuropathy: new concepts and insights. Oxford: Elsevier; 1995. p. 159.
Eckman MH, Greenfield S, Mackey WC, Wong JB, Kaplan S, Sullivan L, et al. Foot infections in diabetic patients: decision and cost-effectiveness analyses. JAMA. 1995;273(9):712–20.
Edmonds ME, Foster AVM. Diabetic foot ulcers. BMJ. 2006; 332:407–10. doi:http://dx.doi.org/10.1136/bmj.332.7538.407
Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey: manual & interpretation guide. Boston: The Health Institute, New England Medical Center; 1993.
Ferreira PL, Ferreira LN, Pereira LN. Medidas sumário física e mental de estado de saúde para a população portuguesa. Rev Port Saúde Pública. 2012;30(2):163–71. doi:10.1016/j.rpsp.2012.12.007. Português. Ferreira PL, Ferreira LN, Pereira LN. [Physical and mental summary measures of health state for the Portuguese population]. Rev Port Saúde Pública. 2012; 30(2): 163–71. doi:10.1016/j.rpsp.2012.12.007. Português.
Ferreira P. A medição do estado de saúde: criação da versão portuguesa do MOS SF-36. Centro de Estudos e Investigação em Saúde da Faculdade de Economia da Universidade de Coimbra. Português. Ferreira P. [The measurement of health: creation of the Portuguese version of MOS SF-36]. Center for Studies and Research in Health, Faculty of Economics, University of Coimbra; 1998.
IBM Corporation. IBM SPSS statistics for Windows, version 22.0 [computer software]. Armonk: IBM Corporation; 2013.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford; 2013.
Sierma V, Thorsen H, Holstein PE, Kars M, Apelvist J, Jude EB, et al. Health related quality of life predicts major amputation and death, but not healing, in people with diabetes presenting with foot ulcers: the Eurodiale study. Diabetes Care. 2014;37(3):694–700. doi:10.2337/dc13-1212.
Dewar A. Nurses’ experiences in giving bad news to patients with spinal cord injuries. J Neurosci Nurs. 2000;32:324–30.
Baile WF, Buckman R, Lenzi R, et al. SPIKES: a 6 step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5:302–11.
Fallowsfield L, Jenkins V. Communicating sad, bad and difficult news in medicine. Lancet. 2004;363:312–9.
Kishblum S, Fichtenbaum J. Breaking the news in spinal cord injury. J Spinal Cord Med. 2008;31:7–12.
Dias MR. Qualidade de Vida Relacionada com a Saúde e Satisfação com a Vida. [Dissertation]. Faculdade de Desporto: Universidade do Porto, Portugal; 2006. Português. Dias MR. [Quality of life related to health and life satisfaction]. [Dissertation]. Faculdade de Desporto: Universidade do Porto, Portugal; 2006. Português.
Tennvall RG, Apelqvist J. Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000;4(5):235–41.
Armstrong DG, Wrobel J, Robbins JM. Guest editorial: Are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4(4):286–7. doi:10.1111/j.1742-481X.2007.00392.x.
Price P. The diabetic foot: quality of life. Clin Infect Dis. 2004;39(2):129–31. doi:10.1086/383274.
Peters EJG, Childs MR, Wunderlich RP, Harkless LB, Armstrong DG, Lavery LA. Functional status of persons with diabetes-related lower extremity amputations. Diabetes Care. 2001;24:1799–804.
The authors gratefully acknowledge the contributions of the Multidisciplinary Diabetic Foot Clinics of the following hospitals: CHP, CHSJ, CHVNG/E, CHTS, ULSAM and the Vascular Surgery Departments in Braga and CHSJ Hospitals. The authors also wish to thank all patients who agreed to participate in this study. This study was conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653). This work was supported by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology.
The authors report that the current study conformed to the Helsinki Declaration concerning human rights and informed consent and followed correct procedures concerning the treatment of humans and animals in research.
Conflict of Interest
The authors declare that they have no conflict of interest.
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Pedras, S., Carvalho, R. & Pereira, M.G. Quality of Life in Portuguese Patients with Diabetic Foot Ulcer Before and After an Amputation Surgery. Int.J. Behav. Med. 23, 714–721 (2016). https://doi.org/10.1007/s12529-016-9567-6